{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:54:16Z","timestamp":1783072456963,"version":"3.54.6"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,2]],"date-time":"2019-04-02T00:00:00Z","timestamp":1554163200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To propose a staging system for congenital lower urinary tract obstruction (LUTO) capable of predicting the severity of the condition and its prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a national retrospective study carried out at the eight Academic Hospitals in The Netherlands. We collected prenatal and postnatal data of fetuses at high risk of isolated LUTO that were managed conservatively. Postnatal renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the Schwartz formula, considering the length of the infant and the creatinine nadir in the first year after birth. Receiver\u2013operating characteristics (ROC) curve analysis, univariate analysis and multivariate logistic regression analysis with stepwise backward elimination were performed in order to identify the best antenatal predictors of perinatal mortality and postnatal renal function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 261 fetuses suspected of having LUTO and managed conservatively were included in the study. The pregnancy was terminated in 110 cases and perinatal death occurred in 35 cases. Gestational age at appearance of oligohydramnios showed excellent accuracy in predicting the risk of perinatal mortality with an area under the ROC curve of 0.95 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and an optimal cut\u2010off at 26\u2009weeks' gestation. Fetuses with normal amniotic fluid (AF) volume at 26\u2009weeks' gestation presented with low risk of poor outcome and were therefore defined as cases with mild LUTO. In fetuses referred before the 26<jats:sup>th<\/jats:sup> week of gestation, the urinary bladder volume (BV) was the best unique predictor of perinatal mortality. ROC curve analysis identified a BV of 5.4\u2009cm<jats:sup>3<\/jats:sup> and appearance of oligohydramnios at 20\u2009weeks as the best threshold for predicting an adverse outcome. LUTO cases with a BV\u2009\u2265\u20095.4\u2009cm<jats:sup>3<\/jats:sup> or abnormal AF volume before 20\u2009weeks' gestation were defined as severe and those with BV\u2009&lt;\u20095.4\u2009cm<jats:sup>3<\/jats:sup> and  normal AF volume at the 20\u2009weeks' scan were defined as moderate. Risk of perinatal mortality significantly increased according to the stage of severity, from mild to moderate to severe stage, from 9% to 26% to 55%, respectively. Similarly, risk of severely impaired renal function increased from 11% to 31% to 44%, for mild, moderate and severe LUTO, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Gestational age at  appearance of oligo\u2010 or anhydramnios and BV at diagnosis can accurately predict mortality and morbidity in fetuses with LUTO. Our proposed staging system can triage reliably fetuses with LUTO and predict the severity of the condition and its prognosis. Copyright \u00a9 2018 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.19172","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T04:13:41Z","timestamp":1530850421000},"page":"520-524","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Antenatal staging of congenital lower urinary tract obstruction"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-4984","authenticated-orcid":false,"given":"F.","family":"Fontanella","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis University Medical Center Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. N. Adama","family":"van Scheltema","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-9973","authenticated-orcid":false,"given":"L.","family":"Duin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis University Medical Center Groningen, University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. E.","family":"Cohen\u2010Overbeek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Pajkrt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Medical Center Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. N.","family":"Bekker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis Radboud University Medical Center  Nijmegen The Netherlands"},{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Willekes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis University Medical Center, Grow School for Oncology and Medical Biology  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M.","family":"Bilardo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis University Medical Center Groningen, University of Groningen  Groningen The Netherlands"},{"name":"Department of Obstetrics, Gynecology and Prenatal Diagnosis VU University Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2016.05.047"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03476.x"},{"key":"e_1_2_5_4_1","volume-title":"Fetal Therapy: Scientific Basis and Critical Appraisal of Clinical Benefits","author":"Khalek NJM"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2009.03.010"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40748-015-0026-1"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8628(19991029)86:5<430::AID-AJMG7>3.0.CO;2-J"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000478011"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14652"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15844"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60992-7"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.8981"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000488282"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18990"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2013.06.016"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1973.tb16049.x"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008030287"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4868"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00252.x"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00228.x"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/ob.1996.v175.a74409"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92609-8"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(82)80437-5"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(90)90818-R"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17422"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.81"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4038"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(00)01020-6"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14652"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15988"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.19172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.19172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.19172","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.19172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T19:46:31Z","timestamp":1720554391000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.19172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1002\/uog.19172"],"URL":"https:\/\/doi.org\/10.1002\/uog.19172","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]},"assertion":[{"value":"2018-02-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}